§ 26.1-36-09.8 — Health insurance policy and health service contract - Postdelivery coverage for mothers and newborns

North Dakota § 26.1-36-09.8

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-36: Accident and Health Insurance

Text

coverage for mothers and newborns.
1. An insurance company, nonprofit health service corporation, or health maintenance
organization may not deliver, issue, execute, or renew any health insurance policy,
health service contract, or evidence of coverage that provides maternity benefits on an
individual, group, blanket, franchise, or association basis unless the policy, contract, or
evidence of coverage provides benefits, of the same type offered under the policy or
contract for illnesses, for health services to any person covered under the policy or
contract for:
a. Inpatient care for at least forty-eight hours for a mother and her newborn child
following a normal vaginal delivery, and inpatient care for at least ninety-six hours
following a caesarean section, without requiring the attending physician or health
care provider to obtain authorization to care for a mother and her newborn child in
the inpatient setting for this period of time.
b. Inpatient care in excess of forty-eight hours following a vaginal delivery and
ninety-six hours following a caesarean section if the stay is determined to be
reasonable and medically necessary.

2. Coverage is not required for postdelivery inpatient care for a covered mother and her
newborn child during the entire minimum time period required under subdivision a of
subsection 1 if:
a. The attending physician or health care provider, in consultation with the mother,
decides to discharge the mother and her newborn child early; and
b. The mother and her newborn child meet the minimum medical criteria for
discharge as recommended in the "Guidelines for Perinatal Care" prepared by
the American college of obstetricians and gynecologists and the American
academy of pediatrics.
3. A person covered under this section is not required to give birth in a hospital or stay in
a hospital for a fixed period of time following the birth of her child or participate in any
postdelivery visit.
4. An insurance company, nonprofit health service corporation, health maintenance
organization, or provider may not:
a. Provide monetary payments to any insured person to request less than the
minimum coverage required under this section;
b. Penalize or otherwise reduce or limit the reimbursement of an attending physician
or health care provider for recommending or providing care that is covered under
this section;
c. Waive any deductible, coinsurance, or copayment requirement for providing the
minimum coverage required under this section;
d. Deny to the mother or newborn child eligibility or continued eligibility to enroll or to
renew coverage under the terms of the plan solely to avoid the requirements of
this section; or
e. Provide incentives, monetary or otherwise, to an attending physician or health
care provider to induce the physician or provider to provide care to an individual
participant or beneficiary in a manner inconsistent with this section.
5. The coverage required under subsection 1 may not exceed policy aggregate limits for
this coverage.
6. This section does not prevent an insurance company, nonprofit health service
corporation, or health maintenance organization from imposing deductibles,
coinsurance, or other cost sharing in relation to benefits for hospital lengths of stay
relating to childbirth for a mother or newborn child under the plan.